碳酸锂联合舍曲林治疗双相抑郁效果研究

Clinical study on lithium carbonate combined with sertraline for bipolar depression disorder

目的探讨碳酸锂联合舍曲林治疗双相抑郁的效果。方法选择2012年8月—2013年1月收治的双相抑郁患者79例,随机分为研究组41例和对照组38例,研究组给予碳酸锂联合舍曲林治疗(碳酸锂从0.25 g/次,3次/d开始,剂量范围依病情调整至1.0-1.5 g/d;舍曲林从50 mg,1次/d开始,剂量范围50-100 mg/d),对照组单用碳酸锂治疗(方法同治疗组),治疗6周末,以汉密尔顿抑郁量表(Hamilton depression scale,HAMD)和副反应量表(treatment emergent symptomscale,TESS)评估病情和不良反应,并比较两组疗效、抑郁症状检出率、HAMD总分和焦虑/躯体化、认知障碍、绝望感、自杀观念因子评分。计量资料采用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果情感低落、兴趣丧失、精力减退、自责症状检出率治疗6周末研究组分别为7.3%、4.9%、9.8%、12.2%,对照组分别为26.3%、31.6%、28.9%、34.2%,两组比较差异均有统计学意义(均P<0.05);HAMD总分、焦虑/躯体化、认知障碍、绝望感、自杀观念因子评分研究组分别为(18.4±3.4)、(5.2±1.2)、(1.8±0.7)、(1.5±0.8)、(1.6±0.9)分,对照组分别为(21.4±3.9)、(5.8±1.4)、(2.2±0.8)、(2.0±0.9)、(2.1±0.8)分,两组比较差异均有统计学意义(均P<0.05);治疗6周末总有效率研究组97.6%,对照组81.6%,两组比较差异有统计学意义(P<0.05)。结论碳酸锂联合舍曲林治疗双相抑郁效果优于单用碳酸锂,是较好的选择。

Objective To compare the effects of lithium carbonate combined with sertraline and lithium carbonate monotherapy for bipolar depression disorder.Methods Seventy-nine patients with bipolar depression disorder treated from August 2012 to January 2013 were randomly divided into two groups： study group（n=41） and control group（n=38）.Lithium carbonate combined with sertraline was given to study group,the initial dosage of lithium carbonate was 0.25g,tid,which could be adjusted to 1.0-1.5 g/d according to disease severity,while sertraline started from 50 rag,once daily to 50-100 mg/d.Control group was treated with single lithium carbonate the same way to study group.Six weeks after treatment,both groups were assessed with Hamilton Depression Scale （HAMD） and the Treatment Emergent Symptom Scale（TESS） for severity and adverse reactions.And clinical efficacy,detec- tion rate of depressive symptoms,total score of HAMD and factor scores of anxiety/somatization,coguition disorder,hopelessness and suicide ideation were compared afterwards.The t-test was used for measurement data, X2 test for count data, and the result of P〈0.05 was considered to be statistically significant.Results After a 6-week treatment,the detection rate of low-spiritedness,loss of interest,self-accusation and decreased vitality were 7.3%,4.9%,9.8% and 12.2% respectively in study group,which were signifi- cantly different from those in the controls （6.3%,31.6%,29.0% and 34.2%;P〈0.05）.The total score of HAMD and the factor scores of anxiety/somatization,cognition disorder,hopelessness,suicide ideation were（18.4 ± 3.4）,（5.2 ± 1.2）,（1.8 ±0.7）,（1.5 ±0.8）and（1.6 ± 0.9） respectively in study group,which were significantly different from those in the controls（21.4 ± 3.9）,（5.8 ± 1.4）,（2.2 ± 0.8）,（2.0 ± 0.9）,and （2.1 ±0.8）,respectively,（P〈0.05）.Clinical efficacy at the end of 6th week after treatment showed significant difference in both groups（97.6% VS 81.6%,P〈0.05）.Conclusion Lithium carbonate combined with sertraline is superior to single use of lithium carbonate for bipolar depression disorder,which is a better choice for bipolar depression disorder.